OBJECTIVES: Currently available gonadotropin-releasing hormone (GnRH) analogues for endometriosis differ in efficacy, side effects, dosing schedule, mode of administration, and out-of-pocket (OOP) costs. This study quantified the importance of features that differentiate among these medications.

METHODS: Eligible English-speaking 18-50 years-old (premenopausal) women with previous 3 years of healthcare coverage, had self-reported laparoscopy-confirmed endometriosis, no gynecological surgery or osteoporosis/bone disease/uterine fibroids history, in the past 3 months. Women were either treatment-naïve with moderate-to-severe pain (rated ≥4 of 10) during their most recent period or GnRH analogue-experienced and were recruited via healthcare research panels. A discrete choice experiment with a surgery opt-out option was used to assess preferences for GnRH analogue attributes, including reduction in dysmenorrhea, non-menstrual pelvic pain, and dyspareunia; impact on daily activities; OOP cost ($5-$350/month); risks of bone fracture and hot flashes; and treatment administration. Relative importance (RI) estimates were computed for each attribute. Data were collected for this ongoing study from December 2021-April 2022.

RESULTS: Of 244 women included in analyses, mean age was 32.2±7.3 years; 84% were White. Mean disease duration was 10.2±7.8 years; abdominal pain (98%) and pelvic pain (92%) were the most common endometriosis symptoms ever experienced. Over-the-counter pain medications (95%) and prescription contraceptives (83%) were the most frequently reported treatments ever used for menstrual/endometriosis symptoms. Monthly OOP cost (RI=23.2) and dyspareunia reduction (RI=22.5) were the most important treatment attributes and were of similar importance to women. Reducing non-menstrual pelvic pain (RI=20.4) and dysmenorrhea (RI=13.6) were more important than changes in impact on daily activities (RI=7.0), risks of bone fracture (RI=4.7) and hot flashes (RI=4.7), and treatment administration (RI=3.9).

CONCLUSIONS: Nearly all women used pain medications and prescription contraceptive treatment. For women, dyspareunia pain relief and OOP cost are most important when selecting an endometriosis treatment, which should be considered in endometriosis treatment shared decision-making.